---
type: claim
domain: health
description: RCT evidence showing complete reversion to baseline 6 months after program ended demonstrates that dietary interventions cannot overcome unchanged structural food environments
confidence: experimental
source: Stephen Juraschek et al., AHA 2025 Scientific Sessions, 12-week RCT with 6-month follow-up
created: 2026-04-01
attribution:
  extractor:
    - handle: "vida"
  sourcer:
    - handle: "stat-news-/-stephen-juraschek"
      context: "Stephen Juraschek et al., AHA 2025 Scientific Sessions, 12-week RCT with 6-month follow-up"
supports:
- Medically tailored meals produce -9.67 mmHg systolic BP reductions in food-insecure hypertensive patients — comparable to first-line pharmacotherapy — suggesting dietary intervention at the level of structural food access is a clinical-grade treatment for hypertension
reweave_edges:
- Medically tailored meals produce -9.67 mmHg systolic BP reductions in food-insecure hypertensive patients — comparable to first-line pharmacotherapy — suggesting dietary intervention at the level of structural food access is a clinical-grade treatment for hypertension|supports|2026-04-03
- Rural food-insecure populations enrolled in food assistance interventions at 81 percent versus 53 percent in urban settings, suggesting rural populations may be more receptive to food-based health interventions due to more severe baseline food access constraints|related|2026-04-17
- SNAP receipt reduces antihypertensive medication nonadherence by 13.6 percentage points in food-insecure hypertensive patients but has no effect in food-secure patients, establishing the food-medication trade-off as a specific SDOH mechanism|related|2026-04-17
related:
- Rural food-insecure populations enrolled in food assistance interventions at 81 percent versus 53 percent in urban settings, suggesting rural populations may be more receptive to food-based health interventions due to more severe baseline food access constraints
- SNAP receipt reduces antihypertensive medication nonadherence by 13.6 percentage points in food-insecure hypertensive patients but has no effect in food-secure patients, establishing the food-medication trade-off as a specific SDOH mechanism
---

# Food-as-medicine interventions produce clinically significant BP and LDL improvements during active delivery but benefits fully revert to baseline when structural food environment support is removed, confirming the food environment as the proximate disease-generating mechanism rather than a modifiable behavioral choice

A randomized controlled trial presented at AHA 2025 examined DASH-style grocery delivery plus dietitian support versus cash stipends in food-insecure Black adults in Boston. During the 12-week active intervention, the groceries + dietitian arm showed statistically significant BP improvement and LDL cholesterol reduction compared to stipend-only control. This confirms the causal pathway: dietary change → BP improvement works when the food environment is controlled.

The critical finding is durability failure: Six months after grocery deliveries and stipends stopped, both blood pressure AND LDL cholesterol had returned completely to baseline levels. Not partial reversion—full return to pre-intervention values. As lead researcher Stephen Juraschek stated: 'We did not build grocery stores in the communities that our participants were living in. We did not make the groceries cheaper for people after they were free during the intervention.'

This is mechanistic confirmation that the food environment doesn't just generate disease initially—it continuously regenerates it. When participants returned to the same food-insecure neighborhoods with unchanged food access, the disease pathway reactivated completely. The intervention proved the causal mechanism works, but also proved that episodic food assistance is insufficient without structural food environment change. The food environment is the system that overrides individual interventions when support is removed.

---

Relevant Notes:
- [[five-adverse-sdoh-independently-predict-hypertension-risk-food-insecurity-unemployment-poverty-low-education-inadequate-insurance]]
- [[food-insecurity-independently-predicts-41-percent-higher-cvd-incidence-establishing-temporality-for-sdoh-cardiovascular-pathway]]
- [[only-23-percent-of-treated-us-hypertensives-achieve-blood-pressure-control-demonstrating-pharmacological-availability-is-not-the-binding-constraint]]
- [[medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate as four independent methodologies confirm]]

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